Emergent coronary artery bypass grafting after a broken Rotablator® drive-shaft

Abstract

A 75-year-old man, who presented with acute myocardial infarction and cardiogenic shock underwent emergency cardiac catheterization, assisted by catecholamine administration, respiratory support with intubation and intra-aortic balloon pumping (IABP). The coronary arteriogram showed a high-grade obstruction of two main branches of the left coronary artery. The occlusion of the left anterior descending coronary artery required immediate treatment. As it was heavily calcified, the cardiologists were forced to use Rotablator®, but the device became stuck and the drive-shaft broke. An emergency coronary artery bypass grafting (CABG) with left internal thoracic artery and saphenous vein graft and mitral valve annuloplasty was performed successfully. The patient was weaned off IABP on the fourth postoperative day, and a defibrillator was implanted on the 81st postoperative day because of heart failure. After these procedures, his general state improved gradually and he was able to leave the hospital, walking alone on the 101st postoperative day. Various reports have appeared describing residual foreign bodies in coronary arteries, and almost 90% of these cases can be dealt with by intravascular procedures, but some need removal by open-chest surgery. An early decision by the cardiologists to go to surgery is recommended to save lives. There has been no previous report of emergent CABG after a stuck Rotablator® tip due to a 'broken drive-shaft'. However, because damage is possible even with reliable devices, there should be no hesitation converting to open-heart surgery in such cases. © 2010 Published by European Association for Cardio-Thoracic Surgery.